Assembly-Line Medicine

This week’s guest columnists are Drs. Ashanti Smith and Ravi Alagugurusamy, Family Practice residents at the University Hospital and Clinics here in Lafayette.

It’s a common scenario now in Lafayette, and nationwide: The child wakes up feeling awful- tired, whining, feverish.  Her throat hurts, and she shivers from chills.  She’s also been coughing.  Mom gives her some ibuprofen, a glass of juice and…she goes back to sleep?  That’s really weird in this normally rambunctious kid, so mom brings her to the doctor.

The waiting room is packed with snotting, sneezing, hacking tots and their bleary-eyed parents. To add variety, one kid throws up.  After hours of waiting, they get a room, the doctor zips in, and proclaims the Influenza swab was positive.  He rattles off an obviously oft-repeated lecture on Influenza, what it is, how to treat it, and how long she’ll be sick.  A long time.  He dashes off to the next goopy patient.  Mom’s handed a prescription, a school excuse, and a paper describing Influenza.

Welcome to assembly-line medicine during flu season!  Doctors and nurses have to crank patients through as efficiently as possible- there’s so many to see!  Let’s unpack what happened above.  First, what is “Influenza?”  It’s the “flu” that you get a flu shot for, and have been hearing a lot about from friends, schools, and the news.  It’s a highly contagious virus that ravages the country every year between October and April- and this year’s been particularly active.

Highly contagious means that you catch it easily, and it’s easily spread to others.  One awful fact: if a kid with the flu coughs in a room, the tiny virus-laden droplets he expels will land on surfaces and remain infectious for 2 hours.  Thus if you touch a table or arm of a chair with the virus within that time, then lick your finger to turn a page, you’ll get it.

This is why the CDC recommends everyone get the flu vaccine every year.  You could inadvertently get it anywhere- school, work, the grocery store.  Okay, so it’s super-contagious.  So what? Isn’t it just some cough and congestion, maybe some fever, and lasts just a few days?

If you’ve ever had Influenza (the “flu”), you now get the vaccine every year, realizing it’s not just a bad cold.  Besides a hacking cough and pouring nose, you have the worst fever of your life- shivering under blankets and quilts despite ibuprofen.  Your head really hurts.  Your throat feels like you’ve swallowed glass shards.  Everything aches.  You have cramps and diarrhea, maybe vomit too.  You wonder- am I dying?

Even worse, it’s been three days with this misery.  At the doctor, more bad news- it can last 7 days before abating!  This is when you make deals with yourself and God.  I’ll never take feeling good for granted again!  I’ll get the flu shot next year!  Make it stop, I promise I’ll be good!

Our hurried doctor from above, running from room to room, stamps out prescriptions and school excuses left and right.  Got to keep the assembly line going- there’s so many miserables to see.  What’s he giving out?  Tamiflu.  Influenza is one of the few viruses for which there’s a medicine that makes it better.

However, it’s not a miracle drug.  Your kid’s not going to pop out of bed next day turning handsprings.  It shortens the course a little- a day or two.  It makes you a little less sick, and also importantly, a little less contagious to those around you.  But you’ve got to start Tamiflu within 48 hours of symptom onset, or it won’t help.

You wonder when you have the flu, am I dying?  Unfortunately, sometimes the flu does kill.  It’s particularly worrisome for the elderly, the pregnant, and the sickly.  Children who are already medically vulnerable- asthmatics, ex-preemies, special-needs kids, kids with heart conditions, are at high risk.  This is a big reason doctors, the CDC, and state health departments insist people get vaccinated.  With the vaccine and hand-hygiene, deaths are preventable!

So get your kid their flu vaccine now- it’s not too late.  Make sure they wash their hands.  And for goodness’s sake, if they have a fever, keep them out of school and get them seen at their doctor’s.  For their sake, and yours!  

You Don’t Want The Flu!

This week’s guest columnist is Dr. Chad Mathews, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

Flu season is here.  If you’ve never had the flu, you’re fortunate.  Dr. Hamilton tells the story of when he had it.  Besides the cough, headache, and body aches, he was under the covers shivering violently from fever despite having taken both ibuprofen and Tylenol.  He was shaking so badly he swore he had something worse than influenza, though tests showed that’s all it was.  Since then Dr. Hamilton gets the shot every year.

The “flu” we’re talking about is the Influenza virus.  It affects all ages, little ones too.  It usually attacks the upper airways, causing cough, runny nose, and sore throat.  It can also affect the GI tract, with vomiting and diarrhea.  What’s universal is a whole week of misery, with headache and fever and hit-by-a-truck fatigue.  It’s particularly rough on babies, and children with asthma, who are at risk for complications like pneumonia and dehydration.

While most viruses have no treatment and must run their course, influenza is one of the few with a medicine that can help- Tamiflu.  Tamiflu may shorten the time kids are sick, and make them less contagious.  It should be started within 48 hours of onset of illness or it won’t help at all, and it only shaves a few days off the week of misery.

Thus the best treatment will always be prevention.  Influenza is highly contagious, easily passed between kids by coughing and sneezing on each other, and touching each other with infected hands; in other words flu is passed when kids “slime” one another.  Kids should therefore be taught to cough and sneeze into their hands or elbow crook, and wash their hands often.

The other extremely effective weapon against influenza is vaccination.  To illustrate the vaccine’s effectiveness, a 2014 study showed 74% decreased pediatric intensive care admissions in vaccinated kids; meaning 74% fewer kids got influenza’s life-threatening complications.  And a flu vaccine not only protects the kid who gets it, but all the other kids around him whom he WON’T infect.

I know one old Cajun who just won’t get the influenza vaccine.  He agrees it’s a good idea and used to get the vaccine every year.  However, he got sick every year right after the shot.  In fact, it seemed he was getting the flu itself- long lasting cough, fever, aches, fatigue, upset stomach.  “Ain’t goin’ do it,” he exclaims, “had enough gittin’ sick from dat shot!”

Like we mentioned above, influenza virus is highly contagious, and highly miserable.  It comes around in wintertime, makes you and your kids feel rotten for a whole week, and spreads easily.  Besides hand washing and avoidance, vaccination is the best way to prevent getting it.

Why do you need a shot every year?  Don’t you stay immune?  Unfortunately, every year the influenza virus changes chemically- it evolves to fool your immune system and sneak by.  So every few years scientists have to make predictions about how the virus might change, and tweak the vaccine’s design. Then you need the new shot to cover the new strain.

What about that old Cajun who believes he gets the flu from the shot?  I’ve encountered other families who refused the vaccine because of this concern.  However, it’s impossible to get influenza from the vaccine.  This is because the virus in the vaccine is either “inactivated,” meaning it’s ability to reproduce in your body has been removed, or the vaccine is “recombinant,” meaning that only pieces of the virus are in the vaccine.

So saying you can get the flu from the vaccine is like saying you are going to drive your car to the store, even though the engine has been removed (“inactivated”), or the only parts of your car available are the steering wheel and a fender (“recombinant”). Either way, you’re not getting to the store.

People who seem to get influenza from the vaccine are actually catching the flu (or other illnesses) around the time they’re getting vaccinated, but before the vaccine can “take.”  If you’re in the office waiting for your shot, and the kid next to you already has it and coughs on you, too late!  You’re going to get sick before your immune system has a chance to build immunity to the virus.  Bad luck!